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Introduction: Despite living donor kidney transplantation (LDKT) being the optimal treatment option for patients with end-stage renal disease, we observed a significant inequality in the number of LDKT performed in our center between patients of Dutch versus non-Dutch descent.

The aim of this study was to investigate factors that may help explain this disparity health care. Therefore we measured the knowledge regarding kidney diseases and renal replacement therapy, risk perception, communication, subjective norm, and willingness to accept a kidney in Dutch and non-Dutch patients with or without a living donor.

Methods: We studied 123 (57 patients of Dutch and 66 of non-Dutch descent) who were referred to our pre-transplant outpatient clinic. All were asked to fill in the Rotterdam Kidney Knowledge-Questionnaire (RKK-Q) which was developed and validated for this study. It contains 30 true/false or multiple choice questions in the field of kidney diseases, haemodialysis, peritoneal dialysis, quality of life (QOL), and transplantation with a living or a deceased donor kidney. Our questionnaire also measured risk perception, communication, subjective norm and willingness to accept a LDKT. The questionnaire was translated into 6 languages.

Results: There were significantly fewer patients of non-Dutch descent (9/66) that brought a living donor compared to patients of Dutch descent (31/57) (p< 0.0001). Multivariate analysis revealed that there were no significant differences in knowledge in patients with or without a living donor (p= 0.110). Non-Dutch patients scored significantly lower on the overall knowledge than Dutch patients (p=.002). However the three-way interaction between knowledge, ethnicity and having a potential donor appeared to be non-significant (p=0.942). This was also the case for risk perception (p=0.570). However, Dutch patients with a living donor have a higher level of communication with their social network than Dutch patients without donor and all non-Dutch (p=0.030).

Discussion: Non-Dutch patients scored significantly lower than Dutch patients on knowledge. Secondly, the non-Dutch patients without a potential living donor show lower levels of communicating with their social network. This minority group seems to an accumulation of unfavorable factors in the context of LDKT. This study shows the importance of tailoring education to the specific background and circumstances of each patient group.